04050145CITY OF CUPERTINO
BUILDING DIVISION PERMIT
CCONTRACT,OWI,NF iiMATIO,N �s
BUILDING ADDRESS:
LINDY ROOFING CO INC
PERMIT "°04050145
1
188S ALMAT)P. AV
OWNER'S NAME:
PERMn ISSUE DATE
ALAN OTA
NE:
SANITARYNO. CONTROL NO.
(408)269-2025
ARCHITECr/ENGINEER:
BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
LICENSED CONTRACTOR'S DECLARATION
Job Description
I bertby s) or But I am Iian,N under vivons of Ckptar Y (rommcaing
p
with Section] lac DlNtlon3af de BUdrcud Profession, Curie, and mYlicemeu
in fulllmce \/
REROOF W /OSB & PRES.COMP.-
Liccnsc CI Lk. N
yeRect.
Date
ARCHITECTS CL
ARCHITECTS DECLARATION
I andcnunJ my plans shell k used as public records
Licensed Pwfnrmoul
OWNER-BUILDER DECLARATION
I homily affirm Nn I am ucmpt from rite Contractors License Law for the
following moon. (Section 703 1.5, Business and Profession, Code: Any city or county
which requites a Permit to ennsWC4 alwt improve, demolish, or mpoir any structure
prior in its issuance, also requiter the applicant for well Permit to file a signed mumem
that he *a licensed pursuant to dm provisions or the Commune's Unarm Law (Chapter 9
Sq. Ft. Floor Area
Valuation
(commencing with Section 7000) of Division J of the Business and Profession. Code) or
mi'man and the um for the alleged exemption. Any violadon of
that he is Attempt de b
A
Section 7071.5 by arty applicant for a permit subjects the applicant a civil penalty of
pplq,(b -00�
Occupancy Type
p y yP
not mart than five Named da1W (MI
� �
0 1. ns owner of rite property, a my employees with wga ss man Win compensation,
-
`� Required'Inspeetlons
will do thework and ths,m char lsnot h mnded or offered forealA (Sec. ]116/, Business
And Profession Cod.: The Com,acmes Lt.. Law data not apply w an owner of
property
own mploye bullmoNmpmvuch Imps ve who do osahwohhimmluedW.ugh his
own employees,lding and that such Improvements art not ear o fe moRemd for commr.
a the Wilding m Improvement b mid within one year a the owner,
/ j
moider r improve for
Wilder will love rive W ben of proving that k did not build m Improve fm purpose of
sale.).
❑ 1, u Awns of the propenY• am l sclusively contracting with licensed contracbn in
construct the pmjea (Sec. 70x4, Business and Professions Code) The Contncura U.
cam raw does not apply in an owner of pmpeny who builds or improves Ikmon, and
who conamb; forauch projeeu with aconmto*7 licen¢d punuant w die Conners
V
License Law.
❑ 1 ten aemps under sec. . B & P c fa this maw.
Owner Dam
WORKERS COMPENSATION DECLARATION
I hereby affirm under penalty of perjury am of the following declarations
I have and will maintain a Certificate of Consent w self-Insum for Wolk2eaCompen-
setlen, ss provided for by Section 77011 of the Labor Code, for the performance of the
work for which this permit is Wood.
❑ I he. and will maintain Watrra Compenadon Insurance, u required by Section
77170 ofthe labor Cook, for the Performance arms work for which this permit is Issued.
My Workers Com matron Tnsuranaarils Plie
/ynumber
carrier. ffbICA (- PoliryJscr m ��°'r -�I D
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(Thor motion need not kcomplewd little Permit is Intone hundmddollm (5100)
or less.)
1 al iry Out in me perfarreance of the work for which this permit 4Issued, I shall not
employ any person in any manner an as in become subject o de Worken' Compcaudon
Laws of CAHfmnm. Data
Applicant
NOTICE TO APPLICANT. IL After making this Certificate of Exemption, you should
become subject in me Worker's Compensation provision, of the Labor Code. you must
forthwith comply with such provisions or this perm it shall k deemed mmked.
CONSTRUCTION LENDING AGENCY
1 hereby Arm that them is a construction lending agency for the Performance of
the wok for which this permit u issmtl (Sec. 7097. Clv. C.)
Lenders Name
Landers Address
1 certify that 1 have mad this application and stew that the above information Is
'
correct I agree to comply with all city and county ordinances and sum laws rcmting to
building construction, and hereby aurhoriam mpmaematim of this city In court upon the
above- mcndonad property for Inspection purpows.
. (We) agree to save. indemnify and keep harmless be City of Cupertino Against
liabilities, judgments, casts and upcnses which may In any way acme against said Cty
f
APPLI aneCUN ERSTANDS AtND WILL COMPLY WITH ALL NON -POINT
Issued by: Date
SOUR REGULATIONS.
Re -roofs
slgnetm. of ApplicanUCOmncwr Oate
HAZARDOUS MATERIALS DISCLOSURE
Type of Roof
Will applicant m (Muni building occupant swm or hands haabl.ua material
u OcfiS.W. by do Cupertino Municipal Codc. Chapter 9.I2, and rite Halm and Safety
y t
aM, . ssslz(.)7 _ .
All roofs shall be inspected prior to any roofing material being installed.
If a roof is installed without first obtaining an inspection, I agree to remove
Will the Applicant ruluw in aaupml sax equipment or devices which
he ter conum fined by the Oey Arca Air pualily MenAgCment
is
S.,
rye arterials for inspection.
Xlb�U
mmad thehu iim25 D5,25quimmonuundcrCkpwftifthA Glding
m vemad Cadea, 05,5 uim=nuu .luCd li Mmuirmckilding
/
) (• /'� (_� /s yL�
IL T
Jae not currently have a anent that it u my resp rsti i' y in Way the occupant of the
myulm a hichmusthemetim.orwasumccofa Ce wof cupanry
/�
Signature fA licant Date
-��- �--� 5�1 (7/m�
All roof coverings to be Class "B" or better
caw >f�aed,sent -
w
CITY OF
UPEkTINO
Community Development Department
Building Division
City of Cupertino
10300 Torre Avenue
Building Department
Subject: Re- roofing policy for the City of Cupertino
Telephone: (408) 777 -3228
Fax: (408) 777 -3333
1. Prior to permit issuance, you must agree to comply with 1997 UBC Standards
and manufacturers specifications on re- roofing.
2. New roof coverings shall not be applied without first obtaining all inspection
and written approval from the building inspector. A final inspection and
approval shall be obtained from the building inspector when the re- roofing
is completed.
3. All roofs shall be inspected prior to any roofing installation.
4. To receive a final sign off from the City, the following steps are
required:
1) Pre - inspection and /or tear off approval.
2) In- progress inspection approval.
• 3) Final inspection approval.
a) Spark arrester installation.
5. If plywood is installed, a plywood nail inspection is required.
6. Any roofing which is applied without first obtaining an inspection,
will require the removal of all new material down to the sheathing,
so a proper City inspection can be performed.
IMPORTANT:
1. Flat roofs must have a minimum of 1/4 " per foot slope and demonstrate
that there is no ponding.
2. An I.C.B.O. report is required to be on the job site at the time on inspection.
I understand and will comply with the above stated policy on re- roofing.
Homeowner's Name: /I LRW CT,4
Job Site Address: D 8g•S 46th ,-rw &v
Roofing Company Name: L wb t1F/A4 r/
A phcanYs Signature:
Greg teel
Building Official
Revised 1/30/03
Printed on Recycled Paper
Date:
•
aCITY0
CUPEkTINO
CITY OF CUPERTINO
REROOF v � °_f
PERMIT APPLICATION FORM
APN # 35"T is D
Date: FL2-i ki
Building Addrgsggs
�L
Owner's Name: Q L at3 m4
BENERGY
Phone #: 255 — -7p q
O I
Contractor: L I ,( ���
Phone #: _ 4�
License #: 2158&2
Contact: ` I h'1
J
Phone #•�g � cZ�
-
Cupertino Business License #:
BSEISMICOM
Type of Roof Covering:
Existing:
Proposed:
❑ Built -Up Roof
❑ Built -Up roof
❑ Asphalt Shingles
Asphalt Shingles
Xp� Wood Shakes
❑ Wood Shakes
❑ Wood Shingles
❑ Wood Shingles
❑ Other (Specify)
❑ Other (Specify)
Number of existing coverings 1
❑ Provide I.C.B.O. Report #
/ To be Removed
❑ Provide Mfgr. Installation Specs.
I Have Read, Understand and Will Comply
With Cu ertino's Tear Off Policy: ❑
Job Description: F noJE
053 lwv , pegs 6,0/P) P.
Residential JZ Commercial ❑
Fire Zone: Yes ❑ No
Confirmed with Planning Dot. if
there are an restrictions: LJ
Cost of Project: oy Type of Construction: Occupancy group:
2,
D00
Qty. if
ADDlicable
Fee Ii)
Fee D~rintinn
Fnn r}rnnn
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BPERMFEE
Bldg Permit Fees
BUILDING
BENERGY
Energy
BUILDING
BSEISMICRE
Seismic Fee Res
BUILDING
BSEISMICOM
Seismic Commercial
BUILDING
BPLANCHK
Plan Check Fee
BUILDING
BUSLIC
Business License
BUILDING
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